Did you know that diarrhea kills 2,195 children every day more than AIDS, malaria, and measles combined? What’s so disheartening about this statistic is the deaths from diarrhea for children under the age of five are easily prevented by increased breastfeeding, the rotavirus vaccine, and improved sanitation and hygiene and access to clean water.
There are, however, innovative interventions that have been created to treat children with diarrheal disease. Diarrhea leads to dehydration and malnutrition. In fact, according to the World Health Organization diarrhea is a leading cause of malnutrition in children under the age of five. With every bout of diarrhea children who go untreated lose essential liquids and salts as well as vital nutrition.
ColaLife, an organization that provides essential medicines and health interventions using the same distribution channels as Coca-Cola, has created an essential diarrheal prevention kit, Kit Yamoyo, that includes zinc tablets and oral rehydration salts. ColaLife believes that if its kit is adopted globally it has the potential to save one million lives by 2015.
As aforementioned the best way to save more children’s lives and prevent diarrhea is through improved sanitation to decrease the parasites in drinking water.
Last week PSI released its latest issue of Impact magazine: The Best Buys Issue. For this issue of Impact, PSI partnered with Devex, Merck for Mothers and PATH to ask one key question: What are the best buys for global health and development? During a two-hour conversation held at the Center for Global Development global health experts and practitioners discussed the best places to invest in global health and the best investments for global health dollars. Overall, health systems strengthening emerged as the biggest best buy in global health. When health systems are improved the costs for key heath interventions subsequently decreases.
Even though health system strengthening is becoming the critical catalyst that will save global health dollars across the board there are affordable interventions that keep more people alive right now. After the discussion at the Center for Global Development I asked PSI President and CEO Karl Hoffmann during a journalist round table what he believes are the best buys for global maternal health. Hoffman cited working to prevent postpartum hemorrhage and preeclampsia as well as investing in family planning are the three biggest best buys in maternal health.
Karen Cavenaugh, Director of the Office of Health Systems at USAID, also mentioned that investments to ensure every woman delivers her baby with a trained health provider is a global health best buy in maternal health. And, Kaakpema “KP” Yelpaala, Founder and CEO of access.mobile said that investments in mobile enabled vouchers that provide pregnant women with rides to hospitals to deliver their babies is proving to be another best buy to improve maternal health outcomes.
Maternal health continues to be a critical problem in low- and middle-income countries. 800 women die every day around the world while delivering their babies according to the World Health Organization. In nearly every case a mother who dies during childbirth can be saved through interventions that work.
Merck for Mothers, a 10-year, $500 million program created to reduce maternal mortality globally and that sponsored Impact‘s Best Buys issue, partners with leading NGOs to keep more mothers alive both in the United States and around the world. For example, last year Merck for Mothers partnered with PATH to fund a report on the best interventions in maternal health. PATH determined that five interventions are key to accelerating progress to achieve MDG 5 including providing greater access to oxytocin which prevents postpartum hemorrhage, introducing and educating health providers on the use of the uterine balloon tamponade that prevents postpartum bleeding, creating simplified dosing of magnesium sulfate to prevent convulsions after childbirth, accelerating improved proteinuria tests and providing better blood pressure devices.* These interventions, of course, will best work when health systems are universally improved, distribution channels are created to supply medicines to low resource settings and when the costs of medicines and supplies become more affordable.
Sita Shankar Wunnava, the Director of Maternal, Child Health and Nutrition at PATH India, knows about maternal health and women in India. An outspoken leader and NGO director Wunnava has over two decades of international global health experience under her belt and knows that behavioral change in India’s rural areas is what will ultimately save more mothers’ lives.
Each year 78,000 women die in childbirth in India and one million babies die before two months. Those numbers are devastatingly high. To combat this high mortality rate PATH implemented the Sure Start program in Uttar Pradesh and Mahrashtra, Indian’s two most populous states, seven years ago.
The Sure Start program works with women in rural areas to teach them how to stay alive when pregnant and delivering their baby. The Sure Start program was created with the understanding the very first step to reversing maternal and child mortality rates begins with education and behavior change. For instance, Sure Start teaches women that if they have swollen feet it’s not just something that normally happens, but there is a great chance she has high blood pressure which can lead to preeclampsia. They also teach women that colostrum, or a woman’s first milk, is essential for a baby’s health and survival whereas traditionally women in rural areas typically squeeze the colostrum out of their breasts in order to get to the white milk. Also, women are educated about the benefits of exclusive breastfeeding instead of supplementing with water and cow’s milk. Now twice as many women in these two Indian states exclusively breastfeed during their baby’s first week of life. Sure Start also teaches women to wrap babies when they are first born instead of immediately washing them which can lead to hypothermia.
In order to change cultural practices the Sure Start program encourages women to have institutional births, that is delivering in a health center instead of at home with untrained birth attendants. They also had to change the way rural people view pregnancy. Women and their husbands did not view pregnancy as an illness and believed health centers and hospitals were unnecessary for delivering a baby. However, through education over the past three years births in health centers have doubled in Uttar Pradesh.
PATH’s Sure Start program recognizes that the key to reducing maternal mortality is to encourage communities to take collective actions to work together from mothers’ groups, to mothers-in-law, health workers, towns’ mayors, and the village as a whole.
While the Sure Start program has been implemented for seven years in Uttar Pradesh and Mahrashtra, there is only one more year of the program remaining. Sita Shankar Wunnava says that program administrators are sharing data with government officials so they can implement these changes through a larger scaled effort.